No, it doesn’t have to be. Many factors play into whether a mother’s perineum tears or not.
Position- Some positions that the mother is in at the time of pushing put less stress on the perineum. Hands and Knees, Side-lying, Squatting, and Semi-recumbent are all gentle positions on the perineum. Sitting up with legs spread apart and feet in stirrups puts a lot of stress on the perineum which makes preventing tears more challenging. It has been said that this last position is the most extreme in putting tension on the perineum.
Technique of Pushing- Moms may not realize but pushing the baby’s head out is an art. The baby’s head is the largest diameter of the baby’s body. If she is going to tear, this is when it will most likely happen. Pushing slowly with pauses helps the tissue around the perineum to stretch. This slow, gentle motion has allowed many women to birth their babies without tears.
If a mom is told that she needs to birth her baby on the very next push, this can fill her with adrenalin to give it ‘all she’s got.’ Often times the baby is very close to being born already when a mom is told this and she can end up with deep tears when she didn’t need to push quite so explosively.
Another factor is whether the mother is numb or not. If she cannot feel anything in that area, she may not know how hard or soft she is pushing. When the baby’s head is crowning is when she really needs her sensory organs working well. Without them, she must cross her fingers and hope that she doesn’t push too hard.
Mom being numb and unable to push adequately is a reason for the physician to pull out the forceps to finish the delivery. A forceps delivery almost always ends up in deep tears.
Practice- In those final weeks of pregnancy when a mom is resting, it is a great time to practice a controlled push in her mind. She can imagine that uncontrollable urge to push that the body gives and practice doing short breaths as if blowing out a candle to assuage that urge to push hard. If she can push softly until the head is born, very often she will have avoided that annoying tear for her postpartum period.
Remember, your baby, your body and your choice.